Second-trimester abortion must be addressed in global strategies to eradicate unsafe abortion and reduce maternal mortality

Unsafe abortion kills 47,000 women every year and leads to complications for millions of women. The risk of death and disability for women undergoing unsafe abortion in the second trimester is particularly high, say Dr. Lisa Harris of University of Michigan and Dr. Dan Grossman of Ibis Reproductive Health in a commentary published in the International Journal of Gynecology and Obstetrics. Therefore, efforts to reduce unsafe abortion and improve maternal health cannot neglect second-trimester services.

Although second-trimester abortions account for a minority of all abortion procedures, unsafe second trimester abortions are the cause of the majority of serious abortion-related complications and death, especially in low-resource settings where the vast majority of unsafe abortions take place. Yet in many countries second-trimester services are not readily available, owing to a lack of trained providers and widespread stigma. Even in countries where later abortion is legal, women still face barriers in accessing the service.

In order to address these barriers, more providers should be trained to perform second-trimester abortions and second-trimester services must be mainstreamed into health services around the world. Access to safe and acceptable medical induction could be greatly expanded by registering mifepristone for second-trimester use and making the drug widely available. In addition, research is urgently needed to determine the extent of the unmet need for safe second-trimester services and to address gaps in clinical knowledge, especially about how to best scale up these services in low-resource settings. Ibis is currently conducting research on these topics and will soon share results from a South Africa study.

While one strategy to reduce unsafe second-trimester abortion could be to help women access abortions earlier in their pregnancies, data show that the rate of second-trimester abortion has remained relatively constant over time, despite advances like the introduction of medication abortion, which has allowed more women to access abortions before nine weeks of pregnancy. Efforts should continue to help women get earlier abortions, but the need for second-trimester abortion will not go away. In order to save women’s lives and improve women’s health everywhere, second-trimester abortion must be included in global and local strategies to improve access to safe abortion.